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Spine Chiropractic:スパインカイロプラクティック
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日時選択
お客様情報
お支払い方法
アンケート
Spine Chiropractic English Appointment Booking Page.
メニュー
メニュー
Chiropractic treatment for individuals aged 70 and above.
40 分 / ¥6,000
変更
日時選択
前の一週間
2025年1月
次の一週間
日時
22
水
23
木
24
金
25
土
26
日
27
月
28
火
11:00
11:40
12:20
13:00
13:40
14:20
15:00
15:40
16:20
17:00
17:40
18:20
19:00
19:40
20:20
休日
お客様情報
姓
(必須)
名
(必須)
メールアドレス
(必須)
電話番号
(必須)
お支払い方法
現地決済
¥6,000
回数券
ログイン予約のみ利用可能
アンケート
Have you received chiropractic or osteopathic treatment before?
Yes
No
回答内容
(必須)
What specific symptoms are you experiencing? You can select multiple answers
(必須)
Chronic Symptoms Ex: Neck/Back stiffness, etc
Acute Symptoms Ex: Slept wrong, acute lower back pain, etc
Joint Symptoms Ex: shoulder, elbow, hip joint, knee, etc
Neurological Symptoms Ex: numbness, etc
Headache / Temporomandibular Joint Pain (whether chronic or acute)
During Pregnancy or Postpartum (If you have pain, please check above)
Balance Adjustment (without pain)
When did the symptoms start?
Chronic Phase (lasting several months to years)
Acute Phase (within 1 to 2 weeks)
Subacute Phase (lasting 1 to 2 months)
I don't have any pain
回答内容
(必須)
What kind of movements cause the pain?
At Rest Ex: sitting for a long time, lying down, etc.
During Movement Ex: bending, turning around, raising the arm, etc.
Constantly, Regardless of Movement
Varies by Day (not consistent)
I don't have any pain
回答内容
(必須)
When does the pain occur?
(必須)
Upon Waking (pain is strongest in the morning)
Daytime Pain (constant)
Night Pain (waking up due to pain)
Varies by Day (not consistent)
I don't have any pain
Open-ended Response: If there is anything you would like to inform me of or ask in advance (if not, “no” is fine), please fill it out and I will address it during your visit.
回答内容
(必須)
If you were referred, please write the name of the person who referred you below.
回答内容
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